Erotism and Chaos

Freud shocked some of his colleagues when he gave sexuality the leading role in both emotional development and the construction of psychopathology (Ellenberger, 1970; Gay, 1988). Sex was first discussed as an instinctual impulse seeking expression and gratification during various phases of emotional development (Freud, 1905). These formulations were made in the context of the psychodynamic viewpoint and psychosexual development.

The foundations of psychoanalysis rested on the vicissitudes of sexual instincts. Inasmuch as Freud concluded that childhood events are of primary importance in shaping the adult character and in determining types of psychopathology, he had to include sexual processes in the earliest phases of emotional life. His opponents were offended by the concept or rather the phenomenon of infantile sexuality; often their reactions were the outcome of moral indignation rather than critical examination. Many detractors equated psychoanalysis with pansexualism and rejected it as a clinical discipline.

Recently, there has been considerable discussion as to whether drive theory, the cornerstone of classical psychoanalytic theory, is as clinically useful as an explanatory concept for the types of patients we see today. In fact, sex appears to have lost considerable significance and prominence in our therapeutic interactions.

Freud frequently described how resistance was usually directed against forbidden sexual impulses and discussed how difficult it was for patients to discuss their sex lives openly (Breuer and Freud, 1895). He stated that patients should be able to discuss both sexual and financial matters with candor and without inhibition, but he knew that he had to work hard to overcome what he considered to be an inherent reticence. Today, the situation, at least on the surface, appears to be quite different.

With many of my patients, sex is rarely discussed. They are married or involved in sexual relationships, but they seldom spontaneously